Takemi Program in International Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Geriatr Gerontol Int. 2021 Aug;21(8):712-717. doi: 10.1111/ggi.14200. Epub 2021 Jun 9.
The study assessed the association between boosting the workforce supply by types of long-term care services and in-home deaths among older people at the municipality level.
A fixed-effect panel data analysis was conducted using administrative data for every 3 years from 2008 to 2014. The outcome was the proportion of home deaths, excluding those due to external factors, such as suicide or accident. The explanatory variables were the full-time equivalent numbers of care workers engaged in in-home services, day services, short-stay services, and long-term care facilities per 1000 population aged 65 years and older. Ordinary least squares estimation was conducted, with standard errors corrected for clustering at the prefecture level, adjusting the covariates.
Analysis included 1706 municipalities. One care worker increase providing day services per 1000 population aged 65 years and older was associated with a 0.09% increase in the proportion of deaths at home (95% CI: 0.008-0.17). Although statistically non-significant, the number of care workers providing in-home services was positively associated with the proportion of home deaths, whereas the number of those providing short-stay services and providing long-term care facilities and nursing home services were inversely associated with home deaths.
Given the increased number of care-dependent older people who opt to stay at home until death, and their informal caregivers who have the burden and stress of care, the findings suggest that policymakers should ensure that the number of care workers for day services is sufficient for supporting care recipients and informal caregivers. Geriatr Gerontol Int 2021; 21: 712-717.
本研究评估了在市一级，通过增加各种长期护理服务的劳动力供应，并将其与老年人的家中死亡人数相关联。
使用 2008 年至 2014 年每 3 年的行政数据进行固定效应面板数据分析。结果是排除自杀或意外等外部因素导致的家中死亡比例。解释变量是每 1000 名 65 岁及以上人口从事家庭服务、日间服务、短期服务和长期护理设施的全职等效护理人员数量。进行普通最小二乘法估计，并对县级聚类进行标准误差校正，同时调整协变量。
分析包括 1706 个市。每 1000 名 65 岁及以上人口中增加一名提供日间服务的护理人员，与家中死亡比例增加 0.09%（95%CI：0.008-0.17）相关。尽管在统计学上不显著，但提供家庭服务的护理人员数量与家中死亡比例呈正相关，而提供短期服务和提供长期护理设施和养老院服务的护理人员数量与家中死亡比例呈负相关。
鉴于越来越多的依赖护理的老年人选择在家中死亡，以及他们的非正式护理人员承担着护理的负担和压力，研究结果表明，政策制定者应确保有足够数量的日间服务护理人员来支持护理接受者和非正式护理人员。老年病学与老年医学国际 2021；21：712-717。
